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SIX FOUNDING PRINCIPLES 1. ‘Nothing about me, without me’ 2. 2 General practice should be locus of integrated General practice should be ‘locus of integrated services’ 3. Consultant opinion is an essential component of Consultant opinion is an essential component of effective integrated services 4. The delivery of integrated services will primarily rest on extended roles for nurses and AHPs 5. Integrated services must incorporate social care 6. Future integrated services should bring together the full range of primary caret: 020 7631 8450e: info@nuffieldtrust.org.ukwww.nuffieldtrust.org.uk

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MEDICINE AND SURGERY ARE DIFFERENT HORIZONTAL HORIZONTAL INTEGRATION ACUTE ACUTE INTEGRATION SURGERY Increased use of TGH site for NHS activity presently done at high l d hi h Enabled through Enabled throughcost in the private sector ACUTE the creation of a and potentially MEDICINE new organisation through service‐level g and full mergers engagement with OFFICE primary care MEDICINE producing a shift in activity in activity VERTICAL VERTICAL FAMILY INTEGRATION INTEGRATION MEDICINE MEDICINE

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CLINICAL BOARD the most powerful body in the ICS... linking the panels directly the most powerful body in the ICS linking the panels directly with the whole group incentive scheme, or professional dividend Orthopedics Multi‐disciplinary team panels General surgery with resource with resource Urology Diabetes allocation powers ENT and standards Gynecology End of Life Care End of Life Care authority – Colorectal overseeing the Mental Health Cardiology move from Unscheduled Care ‘outpatients’ to Cancer Care office medicine, Pediatrics Respiratory and offering collegiate process Ophthalmology control t l RheumatologySix panels in ‘proof of concept’ year ....... another 18 to follow

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CONCLUSIONS SO FAR • A great deal has been achieved through strong clinical engagement and leadership development • ICS provides robust foundations that appear to ICS id b tf d ti th t t accommodate changes • Reinforced through a programme of quality improvement and service redesign d d • Significant issues persist around QIPP/financial balance • Progress with proof of concept has been slower than Progress with ‘proof of concept’ has been slower than anticipated but is speeding up. • Plans for ICO ‘on hold’, awaiting SHA decision • To deliver transformation, a more consistent policy T d li t f ti i t t li framework is needed to encourage integration and provide clarity and directiont: 020 7631 8450e: info@nuffieldtrust.org.ukwww.nuffieldtrust.org.uk

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5 PRACTICAL CHALLENGES 5 PRACTICAL CHALLENGES 1. What goes in shapes what comes out: how can Trafford ensure good data quality / pop’n management? g q y/p p g 2. What shifts in utilisation and finances are expected in Trafford as a direct result of integration? Will integration deliver QIPP agenda? 3. How/when will the system roll out across Trafford? (e.g. all practices; all generalists and specialists) ll ti ll li t d i li t ) 4. What are the opportunities and threats to integrated care from the emerging GP Consortium? care from the emerging GP Consortium? 5. Is there a Plan B?t: 020 7631 8450e: info@nuffieldtrust.org.ukwww.nuffieldtrust.org.uk

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5 POLICY CHALLENGES 1. How is it possible to deliver a new relationship between GPs and physicians in the present choice environment? GPs and physicians in the present ‘choice’ environment? 2. What is the ‘best’ means of delivering population‐based services? (PbR vs capitated budgets) i ? (PbR it t d b d t ) 3. What are the implications of a new GP contract? 4. Accountability vs Authority – what is going on? 4 A t bilit A th it h ti i ? 5. What is the impact of: – New role for local authorities New role for local authorities – Coalition government/politicst: 020 7631 8450e: info@nuffieldtrust.org.ukwww.nuffieldtrust.org.uk